Martuliak Igor, Golubnitschaja Olga, Chvala Lubos, Kapalla Marko, Ferencik Miroslav, Bubeliny Michala, Venglarcik Michal, Kocan Ladislav
Department of Algesiology, Slovak Medical University Bratislava, F.D. Roosevelt University General Hospital, Banska Bystrica, Slovakia.
Predictive, Preventive and Personalised (3P) Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany.
EPMA J. 2024 Nov 15;15(4):739-750. doi: 10.1007/s13167-024-00383-3. eCollection 2024 Dec.
Acute pain is a physiologic, protective life-important warning neurological signal indicating multi-level tissue modulations caused by a broad spectrum of health adverse events such as stress overload, mechanical trauma, ischemia-reperfusion, sterile and infection-triggered inflammation, single- and multi-organ damage, acute and chronic wounds, tissue remodeling and degeneration, amongst others. On the other hand, pain chronification results in a pathologic transformation from the protective pain signaling into persistent debilitative medical condition with severe consequences including but not restricted to phenotype-specific behavioral patterns, reduced quality of life, and cognitive and mood disorders. Who is predisposed to an increased vs. decreased pain sensitivity and to the pain chronification? The motivation of personalized medicine that "same size does not fit all" is getting obvious also for an advanced approach in algesiology. Consequently, an in-depth patient stratification is essential for the paradigm change in overall pain management from currently applied reactive medical services to the cost-effective predictive, preventive, and personalized medicine (PPPM/3PM) in primary (reversible damage to health and targeted protection against health-to-disease transition) and secondary (personalized protection against disease progression) care. To this end, specifically innovative concepts of phenotyping elaborated in this study play a crucial role in patient stratification for predicting pain-associated outcomes, evidence-based targeted prevention of the pain chronification, and creation of treatment algorithms tailored to individualized patient profiles.
The online version contains supplementary material available at 10.1007/s13167-024-00383-3.
急性疼痛是一种生理上的、具有保护作用的、对生命至关重要的警示神经信号，表明由广泛的健康不良事件引起的多水平组织调节，这些事件包括压力过载、机械创伤、缺血再灌注、无菌性和感染引发的炎症、单器官和多器官损伤、急慢性伤口、组织重塑和退化等。另一方面，疼痛慢性化会导致从保护性疼痛信号向持续性衰弱性疾病状态的病理转变，会产生严重后果，包括但不限于特定表型的行为模式、生活质量下降以及认知和情绪障碍。谁更容易出现疼痛敏感性增加或降低以及疼痛慢性化呢？“一刀切并不适用于所有人”的精准医疗理念在疼痛学的先进方法中也日益凸显。因此，深入的患者分层对于整体疼痛管理的模式转变至关重要，即从目前应用的反应性医疗服务转变为在初级（对健康的可逆损害以及针对健康向疾病转变的靶向保护）和二级（针对疾病进展的个性化保护）护理中具有成本效益的预测性、预防性和个性化医疗（PPPM/3PM）。为此，本研究中详细阐述的特定创新表型概念在患者分层中起着关键作用，用于预测与疼痛相关的结果、基于证据的疼痛慢性化靶向预防以及创建针对个体化患者概况的治疗算法。
在线版本包含可在10.1007/s13167 - 024 - 00383 - 3获取的补充材料。
